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2015 HSR&D/QUERI National Conference Abstract

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3025 — Reduced Cardiovascular Disease Risk among Veterans with Serious Mental Illness: 12-Month Results from SMI Life Goals Randomized Trial

Barbaresso MM, VA Center for Clinical Management Research, VA Ann Arbor Healthcare System; Department of Psychiatry, University of Michigan Medical School; Nord KM, VA Center for Clinical Management Research, VA Ann Arbor Healthcare System; Department of Psychiatry, University of Michigan Medical School; Lai Z, VA Center for Clinical Management Research, VA Ann Arbor Healthcare System; Department of Psychiatry, University of Michigan Medical School; Bramlet M, VA Center for Clinical Management Research, VA Ann Arbor Healthcare System; Verchinina L, VA Center for Clinical Management Research, VA Ann Arbor Healthcare System; Kilbourne AM, VA Center for Clinical Management Research, VA Ann Arbor Healthcare System; Department of Psychiatry, University of Michigan Medical School;

Objectives:
Persons with Serious Mental Illnesses (SMI) are more likely to die earlier than the general population, and this gap in mortality is attributable to increased risk of cardiovascular disease (CVD). The Life Goals Collaborative Care (LG-CC) program is designed to address CVD risk factors for patients with SMI by combining customized behavioral change strategies with chronic care management. In this randomized trial, we determined whether patients at a large Midwestern facility with SMI receiving LG-CC, compared to usual care (UC), experienced improved 12-month physical and mental health outcomes.

Methods:
Patients diagnosed with SMI (i.e. major depression, bipolar disorder, schizophrenia) and at least one CVD risk factor receiving care at a VA Outpatient Mental Health Clinic (N = 304) were randomized to LG-CC (n = 139) or UC (n = 145). LG-CC included five self-management sessions covering goal-setting and mental health symptom management reinforced through healthy lifestyles; medical risk monitoring via a registry; and care coordination with general medical providers. Primary outcome measures included changes in CVD risk factors, psychiatric symptoms, and health-related quality of life.

Results:
Among patients completing baseline assessments (N = 284), the mean age was 55.2 (SD = 10.9; range 28-75 years), 15.6 were women, and 17.5% were Black. In preliminary analyses comparing 12-month outcomes among patients in LG-CC versus UC, after adjusting for age and sex, patients receiving LG-CC had reduced CVD risk factors (Framingham risk score), as well as a reduction in psychiatric symptoms, specifically anxiety (GAD-7) and PTSD-related symptoms (PCL-C). Upon further mediator analysis, the change in Framingham risk score is potentially mediated by change in cholesterol (direct LDL) levels.

Implications:
Findings suggest that LG-CC may improve physical and mental health outcomes, notably control of CVD risk factors and psychiatric symptom burden, among VA patients with SMI.

Impacts:
Findings will inform VA transformational initiatives including the Blueprint for Excellence by focusing on improving coordinated care access to integrated mental and physical health treatment, notably for vulnerable Veteran populations; and determine whether a manual-based behavioral medicine strategy (LG-CC) is most effective in improving outcomes.